Lessons from a Year as Just a Nurse

I learned a lot in Kindergarten, but unfortunately, and contrary to popular belief, I didn’t learn everything. It felt like I learned a lot in nursing school, but it still wasn’t enough. I have learned a lot in nursing, in my years thus far of being a nurse at the bedside. But most of all, I have learned exponentially more than I would have imagined in a year of open dialogue with nurses; from nursing students to seasoned nurses. Burnt-out nurses to those still full of naïve passion. These are some of the most valuable lessons I learned and applied in the past year.

Don’t cry over spilled…

Poop. They say don’t cry over spilled milk, but I have worked in NICUs and PICUs and I can tell you that a drop, an ounce, a whole frozen milksicle of hard earned maternal breast milk is certainly worth crying over. I’ve learned to grip that stuff like the world’s last Faberge Egg, heart racing at the very thought of it slipping from my hands to the floor. The perfect details of someone’s handiwork shattering around my Dansko clogs, the whole world in that instant painfully and resentfully aware of the negligent mistake I have made.

The explosive diarrhea that gets on your glove and through a misguided, poorly thought-out, quick swipe of those flyaway hairs out of your face, gets firmly planted on the edge of your curls, causing you to drop the bed pan, splattering it all over the floor, your shoes, pants, the IV pole, and wall with a loud crash that brings even the laziest of coworkers running in your direction. That isn’t worth a single tear, unless it is from an over abundance of laughter hours later over an aptly chosen mudslide at the bar around the corner with your coworkers when the shift is over.

I have learned that my day often, if not consistently, does not go as planned. It isn’t worth my tears though, or even my disappointment. Learning to go with the flow has been a valuable lesson that has come closer and closer to home in the larger and busier units I have worked on. More so, watching the nurses who have burnt out early versus those with impressive staying power seems to be highly correlated with their ability to let things go without getting bent out of shape over it. So don’t cry over the poop, the sputum, the dilaudid you just dropped on the floor… but never, ever, ever drop the breast milk!

What’s gonna work? Team Work!

This is the chorus of a theme song on a children’s cartoon. Working in pediatrics, it seemed to always be playing in the background in all of the moments when I needed the reminder the most.

How am I ever going to make it through this assignment alone?

I would frantically whisper to myself early in the day.

And in that moment the cartoon gerbils, or munchkins, or whoever they are, would musically remind me of how.

I am never alone.

I can tell you a story, that I sat with a lonely patient on my lap, administering his meds one by one through his central line, IV syringe pump on the bed ahead of me. But I wouldn’t be telling the full story unless I added that Molly brought the medications to me from the refrigerator and locked medication bin, going through the patient’s medical profile and verifying one by one that each medication was correct, giving them to me lined up in order of administration time to ease my work of again verifying each medication against my patient’s profile and then his arm band.

I would also have to tell you that Leigh had come in to remove the IV pump from the pole where it originally stood, leaving the IV line taught, at risk of snapping or coming undone. She detangled the many lines and cords to place them safely on the bed. I would need to mention the resident who checked in frequently, relieving me at one point when after hours of sitting I realized I could not hold my bladder another minute. She moved easily into my spot and he stroked her hair instead while I ran to the bathroom.

And I would have to mention Kathy, the nurse on the night shift who relieved me, agreeing to take my place with the patient in her lap, rocking him to sleep and tucking him into bed for the night.

I have learned that I am never, ever alone. In a code, I have had team members already helping out before I have even found my voice to yell for their assistance. The moment before I have become tired from compressions a resident or other nurse has tapped my shoulder and seamlessly taken over. When my patient has passed, and I have felt the sinking loneliness of failure, I have felt more supported and surrounded as each and every person has checked in, asking if I am ok. The charge nurse has sent me away for a deep breath and cold water on my face, and I have returned to a fellow nurse compiling my notes to ease to overwhelming task of documenting the precipitating events in time to accept my next patient.

Teamwork works, and it is often so natural in this environment that it goes unnoticed.

Rise, and shine, and give… the Glory, Glory

If that line doesn’t start the chorus of the children’s song in your head you must have spent less time in Sunday school than I did. But regardless, I have learned in nursing, and in life, the importance of giving the glory somewhere else.

“I don’t believe in God.”

You may say. To which I reply, not a problem! Just find another source. It could be a coworker, an old professor, or the Christmas cactus in your living room. Regardless, if you focus on the glory of what you do going to someone else you won’t miss it if it isn’t there. When you take the glory for yourself you start to expect it, and when it doesn’t come your way you begin to lose your passion and drive. Those feelings of burn out may start to creep in, or even worse, you may begin to resent the patients, families, physicians, who once glorified the work you do and suddenly do not, or haven’t for some times.

One of the issues I see in nursing, and I am as guilty as any other, is that we don’t feel respected, so as a result we are desperate for recognition. There’s a big difference between wanting recognition for the nursing profession and recognition for your self, as a nurse. Don’t mess with the latter, its risky business and can lead you down a slippery slope.

So find where you will send all of your recognition, the your God, your gods, or your team, it doesn’t matter. What matters instead, is that you learn to not find your worth in what you do based on the praise you receive for it.

Talk to Me

I have been so lucky in the past year to be thrust into dialogue with nurses around the world. I have a learned a lot from all of them, about our differences and similarities, new nurses versus the old the staples. But most of all, I have learned that as much as we like to talk to each other about what we do, we do not succeed in telling the world about it. And when we try, for some mysterious reason, it comes out like a laundry list of complaints and requests from martyrdom.

We aren’t martyrs! We chose this profession, and it is time we start treating it like one. If the desire is for nursing to be seen and respected it is time to use our words and eloquently, confidently, to share what we do with society. Instead of complaining that doctors are portrayed in television, recognize that it is because physicians have written books and screenplays and placed their profession there sooner or more often than nurses have. Instead of crying that nurses are portrayed negatively, watch Wolf of Wall Street, Silence of the Lambs… We aren’t the only ones portrayed negatively by characters or stories in film, we are just the group insecure enough to feel defined by it.

We nurses are desperate to be understood but fall short of fixing the problem, so pick your head up, stop whining about long shifts, sore feet, and stunted emotions that come from the work you have chosen to do. Instead, find a way to share the pride you have in what you do.

There is so much more than these three lessons, but I think this is a good place to start. I learned a lot from a year of being Just a Nurse, I learned it all from you. So thank you, and keep up the good work.

Nurse

A year ago today I posted to my hardly read blog about nursing. Apparently my feelings were universal as you, my readers, shared the post globally which to date has been read over a million times on this blog and even more by readers of the Huffington Post. In honor of this important milestone for my blog I have reposted a slightly edited version of the original post here. Tomorrow I will be back with my follow up of what I have learned in a year of being Just a Nurse.

In the first year of my career as a Registered Nurse I continued my education, wrapping up my Bachelor’s Degree in Nursing, not yet a requirement to work as an RN, but a well worth it continuation of a degree to make you a more well-rounded, and in my opinion, respected Nurse. One of the requirements for this degree was a course called “Professional Issues and Trends.” The course explored the profession of nursing, the barriers it is facing, and the way that we, as nurses, can change that. I learned many things in that course, but the most valuable lesson, the thing that has stuck with me the most was this.

A few days into the course, our Professor made one thing very clear; each and every one of us, from that moment on, needed to remove “Just a Nurse” from our vocabulary.

“Are you a Doctor?”

“No, I’m just a nurse.”

I have spent six years since trying to avoid that phrase. More so, I have worked to avoid that feeling. I work hard at what I do, but am often aware that my friends and family have no concept of what nursing really is. I don’t just bring you to your room at the doctor’s office, sit you on the table, and check your normal blood pressure, then go and get the Doctor. Instead, I am often in a room with a small child on a ventilator, multiple intravenous medications infusing through central lines keeping the vascular system constricted or dilated. I monitor blood gases and adjust ventilator settings accordingly. If the blood pressure goes too high I adjust the medications related to these values. I keep my patient adequately sedated and paralyzed, for their safety, without over medicating them. It is often my responsibility to determine this balance.

Recently, I had a nearly two year old patient who pulled his own breathing tube out in the early morning. We weren’t sure whether he would do ok without it so I monitored his respiratory status closely all morning. By mid-afternoon he seemed to be doing well enough. His sedation had worn off and he had no interest in spending another minute in bed. Concerned that he would harm himself moving around through multiple IV and arterial lines, plus a BiPap machine, and monitor leads, I decided to hold him. I was fortunate that day to only have the one patient since he still needed such close monitoring. He had no family present but needed close to a dozen IV medications over the next five hours. I collected them all and lined them on his bed. I pulled his syringe pump that would be used for the medications off of the IV pole and placed it on the bed in front of me. I lifted him out of bed and onto my lap, into my arms. For five hours we rocked and I held him close. He stared into my eyes, played with my hair with his one arm, tried to suck this thumb through IV sites and arm boards. I gave his medications one by one until the nurse who would relieve me for the oncoming shift came in.

I am not just a nurse. I am a nurse. Over the course of a 12 hour shift I can go from interpreting serial blood gases to comforting a sick child while continuing to monitor vital signs, respiratory status, and administer medications.

I am the eyes, hands, and feet of the physician. I am not their eye candy, or their inferior. I don’t stand up when they enter to room. I don’t follow their commands, we discuss the pathophysiology of the patient’s condition and together we make a plan. Often the things I suggest are the course of action we take, other times I learn something new I had not understood from this doctor. They don’t talk down to me, we discuss things together, as a team.

After a disagreement recently over a minor medical decision between myself and a doctor, a friend replied to me,

“No offense Kateri, but obviously we’re going with the doctor over the nurse for this one.”

“You’re just a nurse” they might as well have said, although I know that they did not.

I was surprised by how angry and affected I was. It felt as though the color left my face and the posture left my shoulders. Something inside of me sunk.

The following day I struggled to understand why I was still upset. Surely they had no idea what these words had meant to me, or how they felt. The intention had not been criticism or harm, I was making something out of nothing. Over lunch the following day, as I discussed my new job with my family, it became clear. My job is so much to me, and so much of it is misunderstood. And maybe this is no one’s fault but my own. Sure I’m a nurse… yup some days are sad… yeah, blood and poop don’t bother me. But that is all I say. I don’t tell you what I really do. And the media definitely doesn’t either.

Nurse friends, help me out here, maybe it’s time that we stop pretending we are less than we are, that we do less than we do.

I came across the following blurb this morning. I wrote it a few years ago for Nurse’s Day, and it rings as true today as it did then. I may not be a doctor, but I am a nurse. And if you are someone whose mind says “just a nurse” please, go ahead and ask the nurse you know best what it is that they do. I think you may be surprised.

I am a Nurse. I didn’t become a nurse because I couldn’t cut it in med school, or failed organic chemistry, but rather because I chose this. I work to maintain my patient’s dignity through intimate moments, difficult long term decisions, and heartbreaking situations. I share in the joy of newly born babies and miraculously cured diseases. I share in the heart break of a child taken too soon, a disease too powerful, a life changed forever. My patient is often an entire family. I assess and advocate. Sometimes I wipe bottoms, often I give meds, but that isn’t the extent of what I do. There are people above me, and people below. I work closely with both, without them, I could not do what I do well. I chose this profession and love almost every minute of it. I know I am not alone and I appreciate all of the nurses who work alongside me. Many of them have shaped me into the nurse I am. Someday I will shape others into the nurse they will be. This wasn’t my plan B, it was my plan A, and I would gladly choose it again.

Burnout

Disclaimer: If you don’t live in a big, hot, humid city like New York this analogy may not completely apply to you. However, I urge you to read on and use that brilliant, colorful, imagination of yours to join me on this journey.

You know that feeling in these hot summer months? The temperature is high, the humidity level even higher making it feel at though you may in fact be swimming, not walking down the street? The soft breeze is hot, but still manages to intermittently provide a brief, slight, but welcome relief from the stale, melting hotness. The middle of your back, your scalp, your palms, some days even your knees, are dripping in sweat. The only place on your body that isn’t soaking, is your mouth which feels dry once again the moment you swallow the most recent sip of whatever iced beverage you have chosen to enjoy at that moment.

It must burn extra calories to be hot, because somehow the exhaustion is constant. You feel like you’ve walked up a mountain in the two flat blocks between your apartment and your subway stop. Each step feels heavier, like the world is weighing more densely on your shoulders than it was in the step before. It feels like it will never end, like you will never be cool again. It also feels like it can’t possibly be worse, but then it is.

As you descend the stairs onto the subway platform, the breeze is left behind, and suddenly it seems like such a gift to have had it. Now the exhaustion turns to exasperation. There is suddenly a surge of energy, negative energy in the added heat, humidity, and staleness of the unmoving underground air. The energy turns to aggression. If someone so much as looks at you the wrong way you may snap. The person preaching, snapping their gum, or playing cell phone games, volume on and no headphones makes you clench your fists. The thick air slowing you down is their only saving grace. You glance around, prepared to fight anyone who may try to cut ahead of you in line to enter the train. And even still there is the risk that when you finally do get onto the train, relieved at the site of so many open seats, you are suddenly and overwhelmingly aware that this car isn’t air conditioned today. I’m not even going to go there, because that’s just wrong and something I can’t even talk about!

Anyway, the point is, the moment on the platform dripping in sweat, exhausted and overheated, right before the train slows to a stop and opens it’s cool inviting doors, blasting your face with a rush of cold air, that moment, and the ones leading up to it are a lot like how burn out feels.

It’s suffocating and exhausting. It consumes you and changes you. Changes how you see, feel, and worst of all respond to the people and situations around you. In private, it makes you unhappy, discontent, negative, and in public it makes you miserable to be around. In the workplace, it makes you toxic, even dangerous, especially if your work involves caring for others.

Just under a year ago I began the slow descent into a period of burnout. I was aware of it, each moment as it was happening, each day as my case became more and more severe. I would try to wade off to the side of it, clinging to dry land in an attempt prevent it from infiltrating the person I was and the work I was doing. But eventually, at first in small tugs, and then like a rushing wave, it took over, the current of it was too strong for me to wade against, and it knocked me over and trampled my once optimistic spirit.

The burnout began to infiltrate everything, my personal life, my work life, even my private life of time alone with myself. What started as a little exhaustion turned into full-blown self-loathing and misery.

Find ways to cool your burnout I say with each opportunity I have had to speak to new nurses. It is a reminder I would be well served to share with those more seasoned as well, even myself. Having an escape route from burnout is important. Something that cools you off and gets you back on track feeling rejuvenated and reminded of why you do what you do in the first place.

This spring, as I spoke to young nurses in Maryland and again at Le Moyne College in Syracuse, my own alma mater, I spoke this advice being fully aware of how terribly I was struggling to apply it to myself.

My burnout wasn’t just about work, I felt burnt out of being me. Thinking about it took over what felt like every waking moment. I woke each day hating the early alarm, cursing my dependence on coffee as I squinted my way into the kitchen to brew the day’s first pot. Moments before the shower, I cursed the numbers on the scale whose digits had become an embarrassment to me. After the shower, I cursed each very limited fine hair on my head as I tried with frustration to create the illusion of a thick head of hair. At work, I sat through report burnt out on the selfish girl I had become, spending my morning annoyed with caffeine, weight, and hair while the ventilators and dialysis machines of the PICU had plugged along, trying to support the bodies of sick children; balding heads, narcotic dependent, weight so far below a healthy range.

As each day dragged on, my frustration would grow as my responses were short, my empathy inadequate, my frustrations too quickly leaving my mind and exiting off my tongue in the direction of whoever had challenged or upset me.

PICU Kate, my boyfriend took to calling me. The alias of all of the traits I wish I could permanently hide; my bossy, stubborn, and rude alter ego.

Perhaps most of all I was burnt out knowing that I wasn’t living up to the person I was portraying; the proud nurse, supportive healer, hand holder, team collaborator, self-lover. Each week as I sat down to write, I struggled to find anything honest to say. And so I said nothing.

My posts have been sparse, and for that I apologize. But the good news is this. I gave myself permission to be burnt out. I gave myself permission to slowly cool off rather than force a false fix. And it’s working. I feel like I’m ready to be back. I wake up each morning and choose to have my cup of coffee. I skip stepping onto the scale as each day I try to learn to love what my body does rather than how it looks. I’ve given up on the hair, I’ll buy some clip in extensions soon.

And as for work, I’ve gone through a bit of a transition in recent months. But as my life has proved to show me time and time again, I am once more exactly where I need to be.

I hope I haven’t lost your attention in my brief time away. But if I have, I did it for me, I needed it, and I hope you will welcome me back.

Finally, if this burnout thing seems all too familiar and seems to hit home with that churning in the pit of your stomach, know this, the next cool train is approaching the station, but its up to you to step off of the hot platform and into the air conditioned car. So take a deep breath, step on, take a seat, and breath the crisp cool air. When you are ready, get off and get back out there. I’ll be waiting for you.

Credibility

“Thank you for your credibility, Kate” she said, at the moment I had turned to walk out of the room.

“You said you would be here, and you were” she had continued, in a tone that made her sincerity clear, and validated the surprise I felt at the compliment, the rarity she experienced in giving it.

I had come to her to follow up on a discussion we began the night before. She had made a request that I could not grant at that time, but I had promised to return in the morning to follow up. From early in the morning it was clear to me that I still would be unable to come through for her, to resolve the matter in her favor. I had shown up nonetheless, to apologetically deliver the bad news, in person. I knew I would tell her I couldn’t do it, but that I would continue my efforts to see if the situation would change throughout the day, to at least allow for a continued shred of hope.

I entered the room disappointed, even nervous at the task of telling her no. I had anticipated, at least in the back of my mind, the potential for a confrontational response from her. The reasons for her request were valid, but the outcome she desired was simply not possible. She was obviously disappointed, but understanding. Thankful, if not encouraging, that I continue to try to fix things.

Her words upon my exit had stopped me in my tracks. Gratitude for something with which I always hope to function, but realize is not always present. For if it was, the acknowledgement of my credibility would be moot, as if she had thanked me for breathing.

Credibility. It isn’t about being able to give more, produce more, please people more. Rather, it is about focusing on only making promises I intend to keep, furthermore, promises I actually can keep. Not only that, but credibility requires that I communicate what I intend to do before I begin the process of doing it.

The outcome, for her, would have been no different, regardless of whether I had shown up to tell her myself or not. But if I had chosen to hide, to break my promise, the disappointment she felt would not just be for the outcome, but in me as well.

Since my incident with the mom in the room and the disappointing news I chose to deliver in person, I have shifted my daily focus. It hasn’t been long, but so far the results have been positive. In health care, sometimes one of the major things our families want from us, as caregivers, is a little credibility. The most common complaint I field from the families I have cared for is the inconsistency they see, whether it be an inconsistency between different team members, or even worse, individual inconsistencies. People saying they will do one thing, and never communicating, never acknowledging if or why things have changed. A little credibility goes a long way in building confidence and satisfaction.

And this isn’t just true in hospitals, or even in business. In personal lives we could all use a little more of this too. I think about how often I say I will do something or be somewhere, and how quickly I let things get in the way and change my plans. Some people may call it flaky, but I’m starting to think that, unfortunately, I simply just suffer from a profound lack of credibility sometimes.

But it isn’t too late! I am going to try to fix it. And you probably can fix it too. What better people we would be, better professionals, lovers, and friends if we focused a little bit more on our own credibility.

Home

Given the fact that we just celebrated the 4th of July, a holiday focused on the birth of our country, its independence, and our patriotism, I have been observing the fact that there are a few things we Americans are all about. We love junk food, football, and day drinking. We like thinking we are the best at anything, and even more so, love finding ways to become the best while investing the least amount of effort possible. We love saving those less fortunate than us, using our size and power to protect them. We love cotton candy and cotton, especially if we can eat the former while dressed head to toe in the latter. We love fireworks, hotdogs, and bonfires. All of these things are great, and likely each deserving of their own blog post, but for today I want to focus on this. We, as Americans, love milestones and their celebrations.

So, as such, today it feels appropriate to celebrate the milestone that it has been one year since I began a big scary journey. Actually, realistically, it wasn’t big or scary. I sold my house, moved my life into storage, and moved myself into New York City. I traded a three bedroom, 2000 sq. foot house with a porch, and deck, and a fenced in yard for a studio apartment not much bigger than the unit I was renting back “home” for all of my belongings. I emptied all of the memories out of my first house on Eldorado Street. I said goodbye to my friends who felt like family. I left a job that I loved full of people I respected. I filled my grocery cart one last time at Wegmans. I bought comfortable shoes and I piled a few bins of clothes into my car with my mom for the drive to New York City.

I remember crossing the George Washington Bridge, the city skyline visible to the south as we drove over the Hudson. I remember Washington Heights, and driving down Riverside to the 80’s, admiring the quaint streets and quaint families that inhabited them. I remember being excited by the noise, the hustle, and the infinite options of unknown.

I remember mourning what I was leaving behind, all while hoping, trusting, expecting for it to be replaced with things equally good, maybe even something more, something better.

I am a dreamer, a big thinker, a make-believer. But no game of dress-ups in my childhood, or daydreaming in my adolescence had prepared me to imagine what I would find here this year.

It was probably mid-August before it happened the first time. It was likely a day off. I am sure the sun was shining. I left my apartment, perhaps on an errand, or perhaps, with nowhere special to go. As I walked, the sun hit my face and filled me with warmth. A smile spread across my face and I am sure I giggled like a little girl. I was just so happy to be here. It was a joy I had forgotten, or had maybe never known in my life before.

It was mid-October when a friend from Syracuse texted to ask how I was. I was moving out of my studio and into a one bedroom apartment. I had just survived the famed New York nightmare of finding and renting an apartment. I had sold both of my kidneys and that of my father and a friend to secure the lease of a rent controlled apartment. (There may not have actually been organ procurement involved, but it sure felt that way at the time.) In addition, between first, last, security deposit, and a broker’s fee, I had about $200 in my bank account. My grandmother had saved the day with a loan, my mother had driven a 14ft truck through city streets, and I was finally going to have a kitchen again.

I feel authentic.

I told her.

I had shrunk myself down to fit my life before. I felt like I was constantly changing myself to make things fit right, instead of changing those other things. I finally, for the first time in years, feel completely, authentically, me.

And that has not only continued, but has grown. It feels like longer than a year. The girl I was before feels farther away than last July. I miss my Syracuse friends everyday, and lately I really miss the deck and the grill, and the yard at Eldorado. But the fit I found in the last year, the me I found, and the life I built, I wouldn’t trade that for the world.

I could not possibly have known it yet, but last year, as I drove across the bridge, down Riverside, and turned left toward the park, I wasn’t just moving, I was moving home.

My first night in NYC after a very hot move!

My first night in NYC after a very hot move!

This was yesterday, celebrating my New York-iversary at the Brooklyn Botanic Gardens

This was yesterday, celebrating my New York-iversary at the Brooklyn Botanic Gardens

20/20

Walk a mile in my shoes we say with annoyance, frustration, or that worst of all “I told you so” tone to imply that someone would understand you better if they spent a bit of time being you.

Empathy it screams. Have a bit of empathy, please.

In nursing school that empathy was forced down our throats like a horse pill necessary for daily survival. They drilled us with the difference between sympathy and empathy. Sympathy being pity or compassion for someone, sorrow for their situation without getting so close as to actually feel their pain. Empathy on the other hand, as we are taught, is the far superior alternative of putting yourself in someone else’s position to better understand them and meet their needs. In doing so, we become closer to them and more effective in providing emotional support.

We as a society obsess over each other’s constant lack of empathy. Everywhere you look there is someone blaming the root of a problem on someone else’s lack of empathy. A friend’s callous comment, an ex-boyfriend’s selfish act, a celebrity’s poorly chosen words, even a politician’s one-sided choice. From a distance, one could think that the root all of the world’s problems, according to Americans, siphon down to a lack of empathy.

I disagree. Perhaps it is because the majority of my friends are nurses, although I would argue it is not. But either way, among the people I know and love, the people I observe daily, there is an epidemic more damaging, more widespread, and more palpable than lack of empathy; insecurity.

I have thought about this often in recent months as I transition into a new and different position at work. As I watch my body begin the inevitable changes that the passing of time will cause. As I have battled my weight and the struggles that come when I am not sick and my usual abnormally thin self. When my body plateaus at a more realistic weight, causing clothes to actually fit and not every person I pass to comment on how skinny I am. I feel the need to shrink away in private as my BMI reaches “healthy”, suddenly and unusually insecure in my own skin.

In addition, I have watched my friends as they transition through first pregnancies, difficult break-ups, wedding preparations, and the damaging general culture of female driven feelings of chronic inadequacy. We try to battle against them, but only bury ourselves deeper into our obsession over the unattainable greatness of six pack abs and perky chests. Fooling ourselves into believing that attaining them will make any difference at all.

All I ever wanted was to be captivating. Like in the movies when the beautiful heroine walks into the room and everyone stops. The clink of dishes dulls to silence. The hum of voices falls mute. Forks and hands suspended in the air, mouths full of food, paused mid bite.

My friends wanted to be doctors, lawyers, marine biologists. I wanted to be the girl who leaves you with a mouth full of food, fine silver awkwardly raised, wondering what could possibly be worse; to blink and miss my splendor as you swallow your steak, or to stay there in the moment, soaking me in, wondering why people chew their beef anyways as the tender bite in your mouth grows cold and tough.

When I danced I felt this glimpse of playing captor. How funny it is to strive to trap people in your presence.

Even so, it is all I wanted. To hold them there, watching my body as I turned and jumped, or simply raised my arms in that beautiful way that causes your heart to skip a beat.

Ten years later, there is a man in my life. When he looks at me, I feel myself pulled back onto the stage, spun like Cinderella into a tutu and tights. In his eyes, I feel captivating. In some moments, as I turn toward him and again catch a glimpse of myself in his eyes I begin to wish I could stay there forever. All of my insecurity, inadequacy, and self-loathing melt away. There is no room for them there.

This past week I celebrated my birthday. I spent the day showered with love. One person after another reaching out to express their kind birthday wishes. It brought me back to some of the birthdays of my past. The year my brother stayed up all night creating a beautiful painting for me, then served me breakfast in bed as the paint slowly dried. The year a dear friend filled my hotel room with balloons as our families were all out of town for a wedding the day of my birthday. These acts weren’t just about a well-selected gift or a kind word. They were acts of love. The kind you perform for someone you love and value, the kind that leave the recipient feeling overwhelmingly cherished.

Yet again so very loved on my birthday this year. In fact, I feel so very loved every day. I started to realize how different the way I view myself is from the way others do. To me, I am 130lbs of flaws. I could list them for days and still come up with more. I would tell you my over-confidence is a flaw in one breath and in the next that my insecurity is.

But to the people around me, I am none of those things. I am smart, funny, kind, compassionate, empathetic, tall, skinny, silly, confident, complex, vulnerable, growing, changing, and learning.

So explain to me this. If all of the eyes around me see me that way, why should mine instead trust my own voice giving me the constant list of flaws and faults? Why should you trust your own opinion of yourself over the eyes of those around you?

Perhaps the problem isn’t so much walking in each other’s shoes as it is seeing in each other’s eyes. What if our focus has been all wrong? Perhaps it is finally time to change it, and then maybe, just maybe we can begin to treat our epidemic of insecurity.

Honor Society Induction

I had the honor and privilege last night of being inducted into the Honor Society at Le Moyne College, my alma mater, as a community leader. In addition, I had been invited to give the keynote address for the ceremony which paired both the honor society induction as well as a recognition of the graduates from the nursing programs graduate and undergraduate tracks, separate from the larger school wide graduation they will attend next week. The whole evening was such an honor, as well as a wonderful experience, to be back in a place I spent so much time, yet feels so far in the past. It was wonderful to see the way the program has grown since I was completing my bachelor’s in a cohort of less that 20 students.

I have included below a slightly shorted version of what I spoke to the graduates and inductees last night. I hope you enjoy. And to all those of you with a graduation of your own in the coming weeks, Congratulations!

Le Moyne College Address

Day one of orientation to my first nursing job, in the NICU at St. Joseph’s Hospital, sometime around 8am I decided that Nursing was hard. My orientation had felt like starting over. In many ways, it was, since so little of what I did on a daily basis there had been covered at all by the adult med-surge heavy clinical time of the St. Joseph’s College of Nursing program. I remember on that first day, standing awkwardly, over a human the size of my hand, arms spread, individually inserted through the isolette doors, sweating, as panic took over and I realized that maybe God hadn’t granted me good enough hearing to assess and calculate the heart rate of a neonate, at 180 beats per minute through a cheap disposable stethoscope that crushed into my ears leaving pain for minutes after they were removed.

I hear nothing I panicked.

Wait, is the heart rate really nothing? I wondered, looking to my preceptor for some kind of guidance as the anxiety in me swelled.

Surely she too would look at least a little panicked if this baby were truly pulseless, I comforted myself and listened on. Waiting, as my eyes darted from clock, to baby, to monitor, and back again.

Close your eyes.

I heard, from over my shoulder. And as I did, I began to hear it, the slight, methodical, regular, hum of a racing neonatal heartbeat.

You can do this. I told myself. And finally, I think I started to believe it.

Nursing school had left me feeling run down, as I am sure everyone in this room can appreciate. I began to question everything, chiefly, my decision to become a nurse. In my last semester I had panicked, not yet finding a specialty that seemed to fit. By coincidence I had landed in the NICU. And by the second set of vital signs, eyes closed, I knew I was in the right spot.

Four months into my nursing career, as I finished my extensive orientation, I was back in the classroom at Le Moyne, finishing my bachelor’s in the same place it had all begun, four years prior, having left Ly Moyne after my Sophomore year to attend Nursing School. So in the spring of 2008 as my “college” friends graduated with Bachelor’s degrees I had crossed the stage to accept my Associate’s degree from St. Joseph’s College of Nursing. So there I was, back at Le Moyne to wrap up my degree, while working my first job as a Registered Nurse.

I came into it frustrated. All of my friends were gone, moving on to grad school, first jobs, internships, new cities. Their undergraduate work was behind them. I dragged myself to the first weeks of classes irritated, as if my career, my future, had nothing to gain from another year of college. I knew my parents valued my completing my degree, and somewhere deep inside my stubborn head I too knew I would benefit from it. But at the time, in the moment, it felt useless.

It was a few weeks into the semester when for our Professional Issues and Trends class Barb Carranti guided us to a hidden computer lab somewhere below the science center where we were instructed to write, for an hour and a half, about a day at work. Start to finish, what we did, not the subjective things, but rather, the objective data; the tasks, the procedures, the assessments and subsequent interventions.

To this day, I remember exactly what I wrote. At first I sat there struggling with the assignment, unsure of what to write or how to write it. I stared at the blank document for what felt like hours, struggling to put into words a day of nursing. Finally I gave in, starting with one word, and then another, until suddenly, with a rush I felt physically move through me the words began to pour out and onto the page. It had been my first trip to MRI with an intubated baby. At a few hours of age he had begun having presumed seizures, they continued through the next few days and were confirmed by an EEG. We were taking him to the MRI scan to evaluate the cause by looking at his brain. He had seized on the way down and continued to throughout the test, requiring additional sedation to keep him still for reliable results. Moments after we had returned to the NICU and settled in, the attending physician pulled me aside to tell me the MRI results, prior to sitting the parents down to discuss with them that anoxic injury was seen over 90% of their sons brain. His prognosis was grim. The doctor cried, the parents cried. I too was given permission to cry, and so I closed my eyes, and made no effort to fight back the few tears that finally made it down my face.

As I sat there in the lab, writing about the day, I cried again. This time, the tears came more easily. I was feeling all of the same emotions, but they were different. I was reliving all of the same activities, but they too suddenly carried a new weight and significance.

I learned two powerful things in that lab that day. First, the intended lesson: that what nurses do and what we say that we do are so rarely on the same page. That when we are asked to write or talk about our work we struggle, and usually, we either give up or simply focus on comfort and hand holding. Two incredibly important pieces of what we do, but still, just two of the many pieces. I left class that day with a new ownership over my daily work. A connection to it that has stayed with me in the years since, an awareness of the variety, depth, and importance of the daily tasks and activities a nurse goes through.

The second thing I learned was that I love to write. Not just because I like to string pretty words into powerful sentences. But when I write, when I sit and force myself to make these words, sentences, and paragraphs, I force myself to feel, evaluate, and grow. That growth has made me a better person, a better nurse, a far better advocate for my patients. Since that day I have made an effort to write down the experiences I have that I am struggling to process. In my years as a NICU and then PICU nurse, these experiences have been many.

Writing has allowed me to be vulnerable in my experiences. I am a supporter of nurses being emotionally available to their patients and families, but also firmly believe that at all times we should be the strongest person in the room, not the one falling apart or needing comfort. The risk in developing this ability however, is the opposite extreme, a calloused heart. Through writing, and a decent amount of wine, I like to think I have found a balance that has allowed me to be vulnerable to myself, my family, my coworkers, and now to millions of other nurses around the world.

Last night, as I headed upstate from New York City on the bus, I watched video after video of TED talks. Two of these videos featured Elizabeth Gilbert, the author made famous by the bestseller Eat, Pray, Love. In these talks she spoke about the difficulty of returning home to what you do after great success or great failure, as well as the importance of finding your way back and continuing on.

She referred to your home as the thing that you love more than yourself. For many of us, that thing is nursing, the service to and care of others. Like a best selling writer, we too experience great success and great failure.

For us, the success is not a bestseller, nor is the failure a flopped manuscript or project. For nurses, the catapult to success or failure happens almost daily, some days I have experienced both extremes over the course of a 12hour shift. The failures may be a patient loss, an error, or even more unnerving, the inevitable entrance of burnout, that at least temporarily removes all love and passion from nursing, removes the ability to care well for your patients or yourself, and often leads you down a path to guilt and further feelings of failure.

Success may be placing an IV on the first try, having a family thank you wholeheartedly for your care. Being recognized on your unit by coworkers and administrators for the great work you do, being supported by thousands of nurses around the world for saying what we all were thinking. For many of you, today is the first of these great nursing successes, being inducted into an honor society, recognized for your academic achievements and superior performance.

But like writing a best seller, living in the glory of that success is not a permanent arrangement. It is so important to have a vehicle to bring you back to home, to the core of what is important to you. For Elizabeth Gilbert, it is the writing that brings her back, to her home as a writer. For us though, I think it is more complicated. Leaning on nursing to bring you back to that place is risky. Nursing is rarely neutral, and relying on it too greatly can cause burnout, skewed perceptions, and anxiety. For this, I feel that it is so important to have something else that brings you back to that home.

For me, it has been writing. The expression of not only what I do, but how it makes me feel. The vulnerability in expressing these successes and struggles that has time and time again brought me back to my “home” and grown me into the nurse that I am.

I urge each of you to find a vehicle that will bring you back home. That will temper success and failure and keep you neutral. It may be volunteering, working on a committee, writing, painting, or any one of many other things. Learn to find a place for vulnerability in your work as a nurse, in your life as a human. It will make all of the difference.

By the time I finished my Bachelor’s I had learned to flawlessly complete an assessment despite my arms separated by a plastic wall. I no longer needed to close my eyes to count a heart rate, my ears had become numb to the pinch of a brutal stethoscope. At the point that the anxiety over how to be a nurse shrunk away, the passion for being one crept in. I learned here at Le Moyne College to never say “Just a Nurse”, but once I had reached this point the lesson was unnecessary, that notion was suddenly so far from my truth.

I hope each of you will spend some time basking in the success of today, but that tomorrow you will start to find a reliable path back to your home. I hope that your career will be as full of passion as mine has been, as fulfilling, challenging, and rewarding. Thank you for inviting me here today. It has been my honor. Congratulations.

My parents and me after the ceremony.

My parents and me after the ceremony.